As criticism of the American Health Care Act continues to mount, House Speaker Paul Ryan said the GOP is looking to make adjustments to the law to make it more palatable to some critics and tamp down dissent within the party.
Under particular fire has been the structure of tax credits in the bill, which are based on age instead of income, like those in Affordable Care Act. Though older people will receive more in subsidies, the AHCA would also expand the rate banding rule to a 5:1 ratio, meaning older people could be charged five times more than a younger person for premiums, but would only receive double the government assistance to pay for insurance.
Ryan, R-Wisc., acknowledged in an interview with Fox News’ Chris Wallace on Sunday that this is an area in which the bill could be improved.
“Let me just say, the older, the person in their 50s and 60s—the person in the 50s and 60s does have additional healthcare cost than a person in the 20s and 30s, the tax credit[s] adjust for that. But you’re right in saying, and we agree, we believe we should have even more assistance,” Ryan said. “And that's one of the things we’re looking at for that person in the 50s and 60s, because they experience higher healthcare costs.”
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In fact, an Associated Press analysis of figures from the Kaiser Family Foundation found that counties that overwhelmingly backed President Donald Trump in November’s election would be more likely to see the costs for older enrollees rise 50% more compared to counties that strongly voted against Trump.
“A lot of people just won't be able to afford to pay it. A lot of people are going to drop out of the market altogether,” Cynthia Cox, associate director for the Program for the Study of Health Reform and Private Insurance at the KFF, told the outlet.
Though the changes may contain enough concessions to get Republican voters on board, the bill will still need to overcome strong opposition from some of the more conservative lawmakers, including members of the House Freedom Caucus who say the bill doesn’t go far in enough in deregulating healthcare.
Members of the caucus and other hardliners like Sen. Rand Paul, R-Ky., have called the bill “Obamacare Lite." However, according to an article from The New York Times, members of the Freedom Caucus may be willing to negotiate with Ryan and other Republican leaders in response to voter pressure.
“We are willing to play ball, I think. We’re willing to be open,” Rep. Scott Perry, R-Pa., a member of the caucus, told the NYT. “But we’ve got to know it’s a consideration for you because it’s a concern for us.”
Leaders in the caucus like Rep. Mark Meadows, R-N.C., and other hard-right leaders like Sen. Ted Cruz, R-Texas, met with Trump aides, though not the president himself, at Mar-a-Lago over the weekend to discuss their demands, according to Politico. Their discussion came as a vote on the bill nears, likely later this week.
With Trump and congressional leaders working together to push the bill through, their continued opposition could be risky politics.
“I think they come back Monday, they do a little more posturing and then I think at the end of the day they’re going to get on board,” one senior GOP source told Politico.
Though the hardline conservatives remain a question mark going into a vote, Trump and his team did successfully push another group of reticent Republicans to fall in line and support the AHCA, The Wall Street Journal reported. While meeting Friday with 13 lawmakers, including representatives from the Republican Study Committee, Trump backed tighter restrictions on Medicaid funding and work requirements for its low-income enrollees, earning the support of those in the meeting.
However, it’s unclear if the positive response from those at the meeting reflects similar feelings from the Republican rank and file. The changes could also create more problems for the bill in the Senate, according to the article.
Despite that, Trump said at a press conference Friday that factions were “all coming together” ahead of a vote on the bill.
“You have the conservative groups, you have other groups; everybody wants certain things,” Trump said.